Provider Demographics
NPI:1558903955
Name:ANDERSON DENTAL CENTER HACKENSACK LLC
Entity Type:Organization
Organization Name:ANDERSON DENTAL CENTER HACKENSACK LLC
Other - Org Name:ANDERSON DENTAL CENTER OF HACKENSACK LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED IBREHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-SAMNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-546-7435
Mailing Address - Street 1:15 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4508
Mailing Address - Country:US
Mailing Address - Phone:201-546-7435
Mailing Address - Fax:
Practice Address - Street 1:15 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4508
Practice Address - Country:US
Practice Address - Phone:201-546-7435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty